Carbapenem Case 1

Mr. D. is a 68 y/o man who presents to the emergency room with severe left lower quadrant abdominal pain (8/10), nausea and vomiting. He recalls being more constipated over the last few days, and has been using PRN sennosides with no avail.

His current medical conditions include hypertension, diabetes and dyslipidemia, controlled with metformin, ramipril and atorvastatin. In addition, he has a history of sigmoid diverticulosis, but has never been diagnosed with diverticulitis. He also has a remote history of bowel cancer, treated successfully with a bowel resection and chemotherapy in 2009. His antibiotic use has been limited to Moxifloxacin 400mg PO daily X 7 days, taken 4 months ago for a “cold”.

His abdomen is tender and distended on exam. He has a temperature of 38.0 and a pulse of 102 bpm.

Laboratory findings reveal mild elevation in WBC (11.1 X 10*9/L), but are otherwise normal.

An abdominal CT scan reveals localized sigmoid colon thickening of 6mm with fat stranding and various colonic diverticula. A small abscess is present adjacent to the area of inflammation, measuring 4cm x 2cm.

He is started on imipenem/cilastatin 500mg IV q6h and transferred to the general surgery ward. CT guided drainage is currently being considered.

Would you change his imipenem/cilastatin therapy, and if yes, to what agent?

Responses are in alphabetical order.


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